Gerry Shih, Lena H. Sun and Katie Mettler
As the rate of new coronavirus cases appears to be slowing in China, thousands of cruise ship passengers who have been exposed to the virus in Japan and Cambodia are posing logistical and public health challenges as officials try to send them home while prioritizing containment.
The U.S. government evacuated hundreds of Americans on Sunday night from the Diamond Princess cruise liner, docked in Tokyo and quarantined since Feb. 5, and flew them out of Japan on two chartered planes bound for U.S. military bases - a carefully monitored process that will include another quarantine once they land.
Another 44 Americans aboard the Diamond Princess tested positive for coronavirus and will stay at hospitals in Japan as they recover, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told The Washington Post on Sunday.
At the same time, public health officials scrambled to determine whether passengers onboard a different cruise ship, the Westerdam, were exposed to the virus after an 83-year-old woman tested positive days after disembarking in Cambodia. The unexpected finding upended a basic assumption by several governments, including the United States, that the ship was virus-free, which motivated local and U.S. officials to allow passengers to disembark and depart for other cities and countries around the world.
As these cruise passengers and other travelers fan out across the globe, infectious-disease experts say the dynamic illustrates how the virus could be introduced into new communities in quiet ways. Until now, officials have been aggressively monitoring those who traveled to China and those who have had close contact with an infected person. But the Westerdam oversight demonstrates how travelers without obvious symptoms could slip through screening processes.
"This illustrates there is transmission occurring in unexpected places that we're not aware of," said Jeff Duchin, health officer and chief of communicable disease epidemiology section at Seattle and King County health department. "The virus is moving very quickly and silently and presents a real challenge to containment."
Duchin noted, however, that the reported cases occurring in places outside China are not large-scale yet. Health officials still need to focus on where they can have the greatest impact on controlling the outbreak, he said, which is in China.
"But increasingly, we are seeing it pop up in other parts of the world and in other settings, and that makes it difficult for us as a country to know when someone who may have been exposed outside of China enters the United States," Duchin said.
Health experts have warned that the coronavirus is difficult to contain precisely because symptoms are often mild and the coronavirus could replicate inside the human body and infect others for up to 14 days before showing symptoms at all.
As of Sunday, the World Health Organization has reported cases in 26 countries, the majority of which remain in mainland China. Chinese officials have tallied about 70,500 cases of the illness and 1,770 deaths. Outside of China, the WHO reports about 680 confirmed cases and three deaths.
In Japan, U.S. passengers were faced with a difficult decision. They could stay on the Diamond Princess until Feb. 19, when the original quarantine is scheduled to lift, but risk being stuck in Cambodia and bound by commercial flight restrictions, or leave on the chartered flights to military bases in Texas and California - only to face another 14-day quarantine.
About 400 Americans were on the cruise ship when it docked in Japan, and the Japanese Defense Ministry said 300 of them disembarked Sunday night, The Associated Press reported.
The number of coronavirus diagnoses has continued to rise sharply among the 3,700 passengers and crew members originally on board. Japanese Health Minister Katsunobu Kato said early Sunday that the quarantined ship floating near Tokyo has 355 confirmed cases, or about 30% of the 1,219 people who have been tested. That represents one of the highest infection rates in the world.
Consider the fact that thousands of people on board that ship may have been infected just yesterday, or today or tomorrow. They won’t show symptoms for up to 24 days, and they won’t test positive for the coronavirus until much later in the incubation period.
While some passengers are opting for government-chartered evacuation plans, others are about to board commercial planes and fly to their destinations across the world, all with zero quarantine protections. Once there, they won’t be subjected to any further quarantine measures by their local governments, since they can claim they’ve “already been through a 14-day quarantine” on board the ship (which is false, technically speaking, see below…). A week or two later, they may develop full-blown symptoms, and during this entire incubation period, they may be spreading the virus to others in their local communities.
Apparently, no government health authorities have yet realized that a quarantine which allows shared air among the quarantine participants is no quarantine at all because cross-infections can be initiated during any day of the 14-day quarantine. A real 14-day quarantine must secure total isolation for all participants so that each individual is isolated from all others for the entire duration of the quarantine. That’s the only way you can know they aren’t infected. (And technically, it needs to be 24 days, not just 14.)
Yet that protocol is not being followed here.
Every rational, intelligent person knows that a 14-day quarantine doesn’t count if you have infected people sharing air with non-infected people, combined with an airborne disease that has a 24-day potential incubation period. Just holding people on a ship for 14 days does absolutely nothing to guarantee that new people weren’t infected on day 13, for example.
Note carefully that the infections on the Diamond Princess currently represent about half of all the infections outside China. Clearly, the risk of yet more passengers being symptomless carriers is extremely high, yet health authorities are allowing these individuals to exit the ship in two days and walk right into public airports.
Yes, we feel extremely sorry for those individuals, and they’ve been through a horrible ordeal as involuntary prisoners in a floating quarantine camp. But until they’ve spent 24 days completely isolated from other potentially infected individuals, it isn’t a real quarantine. It’s just what I call “medical theater.”
So instead of carrying out a real quarantine, we have the theater of a quarantine. It’s all being done to try to convince the public that really powerful, intelligent people who know what they’re doing are in charge and protecting us from germs. Yet, in reality, it’s being run by clueless, incompetent bureaucrats who seem to have little understanding of the very basic principles of how infectious disease spreads.
Sadly, we will all have to pay the price for their incompetence since it only takes 4-5 infected people to set off a sustained human-to-human outbreak in any given nation. It looks like that day will soon arrive for many nations far beyond China, thanks to Japanese health authorities earning an “F” in basic medical science.
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